Hospital Coding Compliance Plan

 

Facilities can limit their exposure to claim denials and external reviews by implementing a robust internal coding compliance program, including a policy and plan.

 

Basic guidance on how to develop a compliance policy is available from the Office of Inspector General (OIG). The policy should be brief but clearly state the reason for and extent (scope) of the plan. Consider the following example of a compliance policy for a physician group:

 

The coding compliance plan may be a subsection of the policy. If you format the compliance plan as a subsection, the document should be labeled “Coding Compliance Policy and Plan.” The plan component should be much more detailed and include the specifics of what, when, and how often. Each organization should tailor its coding compliance plan to its organization. When developing a new coding compliance plan, managers should begin by asking these questions:

 

• Why am I establishing a plan?
• What will I review?
• How will I select a sample?
• How will I assess accuracy?
• What action will I take when the results are known?
• How will I monitor progress?

 

Fill out the form to access an example of a coding compliance plan that you could implement at your facility.